Mesotherapy with Ascorbic Acid for Treatment of Gingival Hyperpigmentation

Syed Adil Tanvir; Muhammad  Sharjeel; Asma Wahid  Ali khan; Yasir Ikram  Ahmed; Aliza  Abbas; Natasha  Fatima

doi:10.51253/pafmj.v76iSUPPL-1.13103

Authors

Syed Adil Tanvir Department of Dentistry, Armed Forces Institute of Dentistry, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Muhammad Sharjeel Department of Dentistry, Armed Forces Institute of Dentistry, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Asma Wahid Ali khan Department of Dentistry, Armed Forces Institute of Dentistry, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Yasir Ikram Ahmed Department of Dentistry, 28 Military Dental Center, Lahore Pakistan
Aliza Abbas Department of Dentistry, Armed Forces Institute of Dentistry, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Natasha Fatima Department of Dentistry, Armed Forces Institute of Dentistry, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-1.13103

Keywords:

Gingival hyperpigmentation, Intraepidermal injection, Melanin production, Surgical depigmentation, Vitamin C

Abstract

Objective: To evaluate the effectiveness of mesotherapy with Ascorbic Acid (Vitamin C) in the treatment of gingival hyperpigmentation.

Study Design: Quasi-experimental study.

Place and Duration of Study: Armed Forces Institute of Dentistry Rawalpindi, Pakistan, from Feb to Aug 2024.

Methodology: A total of 46 patients with gingival hyperpigmentation were divided into two groups, each treated with a different method of gingival depigmentation. The patients were grouped according to the intervention they received i.e., the surgical method vs the non-surgical (Vitamin-C injections) and the clinical evaluation was conducted both at baseline and post-operatively at 1 week, 1 month (short-term follow up) and 7 months (long-term follow up). Gingival depigmentation was assessed using (Takashi and Kumar indices). Treatment outcomes in terms of both pain score and itching score was evaluated at day 1, 2, 3 and 7.

Results: All patients completed the follow-up sessions and their mean age was 39.04±9.66 years. No significant difference in gingival depigmentation according to both Takashi and Kumar indices at baseline, week 1, and 9 months was observed. In contrast, a significant difference was observed at short-term follow up according to Takashi index (p=0.022) and Kumar index (p=0.008). significant difference in pain and itching at all time points (days 1, 2, 3 and 7) between the control and test group was observed.

Conclusion: Vitamin C injections offer comparable results to surgical depigmentation and may ensure long-term gingival color stability when used post-surgery.

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References

1. Sandhu A, Jyoti D, Sharma H, Phull T, Khurana NS, Tiwana JK. Efficacy of topical vitamin C application on healing after gingival depigmentation by scalpel: A case series. Cureus 2023; 15(11): e48417. http://doi.org/ 10.7759/cureus.48417

2. Yussif NM, Rahman ARA, ElBarbary A. Minimally invasive non-surgical locally injected vitamin C versus the conventional surgical depigmentation in treatment of gingival hyperpigmentation of the anterior esthetic zone: A prospective comparative study. Clin Nutr Exp 2019; 24: 54–65. http://doi.org/ 10.1016/j.yclnex.2018.12.003

3. Jazzar A, AlDehlawi H. Efficacy and risks of different treatments for oral hyperpigmentation: A systematic review and network meta-analysis. J Clin Med 2023; 12(20): 6567.

http://doi.org/ 10.3390/jcm12206567

4. Patil KP, Joshi V, Waghmode V, Kanakdande V. Gingival depigmentation: A split mouth comparative study between scalpel and cryosurgery. Contemp Clin Dent 2015; 6(Suppl 1): S97–S101. http://doi.org/ 10.4103/0976-237X.152964

5. Muruppel AM, Pai BSJ, Bhat S, Parker S, Lynch E. Laser-assisted depigmentation—An introspection of the science, techniques, and perceptions. Dent J 2020; 8(3): 88.

http://doi.org/ 10.3390/dj8030088

6. Dawar A, Kamra P, Anand D, Nayyar V, Mishra D, Pandey S. Oral mesotherapy technique for the treatment of physiologic gingival melanin hyperpigmentation using locally injectable vitamin C: a clinical and histologic case series. Quintessence Int 2022; 53(7): 580–588.

http://doi.org/ 10.3290/j.qi.b3044857

7. Nguyen NT, Wei SH, Sako K. Effect of topical and injected Ascorbic Acid on gingival depigmentation: A systematic review. Clin Oral Investig 2022; 26(4): 2017–2025.

http://doi.org/ 10.1007/s00784-021-03985-7

8. Martinez-Blasco A, Monzón A, Gutierrez-Pérez JL, González-Moles MA. Efficacy and safety of vitamin C injections for gingival depigmentation: A clinical trial. Int J Oral Maxillofac Surg 2021; 50(4): 499–505.

http://doi.org/ 10.1016/j.ijom.2021.01.009

9. Yamanaka T, Nakano K, Okubo A. The effect of vitamin C derivatives on melanin production in human oral keratinocytes. Biochem Biophys Res Commun 2020; 526(2): 351–356.

http://doi.org/ 10.1016/j.bbrc.2020.01.033

10. Tseng H, Lin J, Chen Y. Antioxidant therapy in gingival depigmentation: Clinical efficacy and patient satisfaction. J Clin Periodontol 2021; 48(9): 1073–1081.

http://doi.org/ 10.1111/jcpe.13514

11. Haque AU, Lal N, Kaushal S, Rastogi P, Singhal R. Vitamin C-Based Gingival Depigmentation Versus Surgical Depigmentation: A Randomized Clinical Trial. Sci World J 2024; 2024: 3299188. http://doi.org/ 10.1155/tswj/3299188

12. Kumar S, Bhat GS, Bhat KM. Comparative evaluation of gingival depigmentation using tetrafluoroethane cryosurgery and gingival abrasion technique: Two years follow up. J Clin Diagn Res. 2013; 7(2): 389–394.

http://doi.org/ 10.7860/jcdr/2013/4689.2768

13. Murugesan P, Ramakrishnan T, Karthikeyan BV, Vijayasankari V. Comparative evaluation of different gingival depigmentation techniques: A clinical study. J Indian Soc Periodontol 2015; 19(1): 67–71. http://doi.org/ 10.4103/0972-124X.148646

14. Kumari R, Shetty HS, Shreeya A. Clinical efficacy of vitamin C injection in the management of gingival melanin pigmentation: A randomized controlled trial. Int J Oral Health Dent. 2021; 7(1): 33–38. http://doi.org/10.18231/j.ijohd.2021.006

15. Kumar S, Chandra S, Jaiswal R, Singh K. Gingival depigmentation: A comparative study between scalpel and laser techniques. J Clin Diagn Res 2018; 12(3): ZC23–ZC26.

http://doi.org/ 10.7860/JCDR/2018/31417.11261

16. Takashi T, Moriyama K, Yamada S. The role of antioxidants in non-surgical gingival depigmentation: A clinical and histological study. Oral Dis 2020; 26(2): 231–238.

http://doi.org/ 10.1111/odi.13245

17. Deepa D, Pradeep AR, Kalra N. Long-term evaluation of gingival repigmentation following different depigmentation techniques: A randomized controlled trial. J Periodontol 2019; 90(2): 165–173. http://doi.org/10.1002/JPER.18-0217

18. Kaur R, Gugnani S, Dhiman S, Bhaskar N. Post-operative pain and healing after surgical versus chemical gingival depigmentation: A randomized clinical trial. Contemp Clin Dent 2021; 12(4): 367–372.

http://doi.org/ 10.4103/ccd.ccd_157_21

19. Esmat M, Nasr M, Samy A, Khalil H. Comparative evaluation of vitamin C mesotherapy versus diode laser for gingival hyperpigmentation management: A randomized clinical trial. BMC Oral Health 2023; 23(1): 614.

http://doi.org/ 10.1186/s12903-023-03614-7

20. Swarna MP, Subasree S. Comparative assessment of gingival depigmentation using scalpel versus microneedling with ascorbic acid: A randomized controlled trial. Cureus 2024; 16(4): e58285. http://doi.org/10.7759/cureus.58285

21. Crisan D, Lupsor M, Boca A. The role of antioxidants in gingival depigmentation: Clinical and histological perspectives. Arch Oral Biol 2015; 60(7): 1029–1035.

http://doi.org/10.1016/j.archoralbio.2015.03.015

22. Seo KY, Kim MJ, Park SH. Topical application of vitamin C in the treatment of gingival pigmentation: A clinical evaluation. Int J Oral Sci 2018; 10(4): e27.

http://doi.org/10.1038/s41368-018-0035-4

23. Yamada K, Kobayashi H, Ito T. ROS production and keratinocyte activation in response to vitamin C injection in gingival tissues. J Biochem 2015; 157(3): 223–231.

http://doi.org/10.1093/jb/mvu085